Posts Tagged ‘Physiology’

Hang on just a minute I can hear you think: You haven’t told us about Rule Number 1 and 2 yet?

Well to summarise; Rule Number 1 is “Breathe”. Doesn’t sound too difficult as it is one of the most basic life reflexes, and after sitting by the bedside of a dying person I can tell you just how innate and strong that reflex is. My kid’s got sick of me teaching this Rule at a very young age – Every time they had a fall or fright, and as a parent you watch that “hold” of the breath, and sense that rising of the anxiety and panic in their physiology, I would place a reassuring hand on their shoulder and firmly say “Breathe!” Breath control is a key to controlling our internal homeostasis but it’s not what I want to highlight today.

Rule number 2 is “Keep Moving” or as it was chanted in Finding Nemo “Just Keep Swimming”. Some of my practice members look a little bemused when they present in an acute inflamed state and ask – “should I rest?” And my standard response is “you need to keep moving, but gently!” Perhaps they are secretly craving a few days flat on their back in bed, with a small bell to ring to beckon their spouse to bring more fluids? Rule number 2 is a critical ingredient to any endeavor in life but it is not today’s topic.

So that gets us up to Life Rule Number 3: “Do Something Different” – I think I also learned this principle as a young parent. As your children begin to explore and attempt new milestones but at times reach a point of frustration when trying to do something new, by repeating the same unsuccessful steps. As a “mentor” it would be quick and simple to step in and show your “student” the correct way to do it – but a better life application lesson will come if they discover the solution – so instead we can summarise the best possible advice as “Do Something Different”. This doesn’t mean we turn a blind eye and leave them to figure it out, it would be better for us to make an alternative single suggestion, “reach your hand over a little further this way”, “why not try turning that block over on its side instead?”

Let’s jump for a moment into practice life and hear the Life Rule again – “Do Something Different”. Think of the practice member that appears to be responding poorly or too slowly to your care plan: This is a simple one – “Do Something Different”. Change the technique, change the schedule, change the home advice – makes obvious sense? The worst cases of over-servicing that we hear of in our profession are nearly always a case of a person with a complex health concern who is signed up for a long program of care, and then subjected to the same recipe book visit regardless of the course of their concerns. Having said that I do not believe that over-servicing is a widespread problem in our “culture”. Actually I strongly believe that under-servicing is the most serious negligence which exists at epidemic proportions in our society – there are very few people in our world that are suffering from too many adjustments – but there are far too many suffering from too few!

But this essay is not quite as simple as this – what about the person who is a loyal customer that might potentially see you on an ongoing basis for years to come? “Do Something Different!” Now I may ruffle some chiropractic feathers at this point. But the warning is to avoid the “if it ain’t broke then don’t fix it” philosophy. We supposedly reject this philosophy on the basis that prevention is better than a cure. When someone is out of pain we beseech them to continue with care, but if that care is the same neurological encounter on each and every visit from that point forwards then is that really any different – You see Maintenance is not Wellness?

Look at this from a few points of view:

1) The nervous system adapts and evolves based on its perception and response to every stimulus: So if the stimulus that you provide each week/fortnight/month is the same again and again then what evolution is going to occur as a result of your input? Let me simplify it this way – does your “technique” allow you to perform a live analysis of someone’s state right there and then so that you can provide an adjustment that is responsive to their neurological needs on that given day? Sorry to say but too few techniques truly offer this.

2)If the body is a self-healing organism, then why are you still correcting the same Subluxations that you chose on the first visit? I hear the arguments about scar tissue and degeneration, and “patterns” – but if your adjustment is initiating change, and healing and progression, then surely something has to change therapeutically at some point? In Torque Release Technique we argue that this should be occurring on every visit…

3) Chiropractic is about maximizing human potential: Doesn’t this mean that a person who is in their fifth year of care will probably need more advanced care than someone in the first? As an elite masters’ athlete, my training program develops in intensity and complexity within a short term and long term time-frame. I made my comeback to competitive athletics in 2008, and training methods have changed somewhat since my former aths career in the 80s. Even though I am approaching the 50 milestone, the training that I am doing in 2013 is more advanced than the training I was doing in 2008. And the training that I am doing in February 2013 is higher quality and more technical than the training I was doing in December 2012, as I approach my peak for state and national championships. This is contemporary sports science: But, I’m not convinced that this has pervaded contemporary chiropractic science.

Let me illustrate this with a scenario that I know we have all seen in practice: A person comes in to see you and they are in a bad way. You perform whatever analysis you do, go to work with your healing hands and send them home with some tips to keep them occupied till they next see you. They come back next time and praise you for your majestic healing powers and share their testimonial of retracing and insight. Now you have a quandary – you want to give them the same amazing experience each and every visit – so you rush back to your notes to try and discern what it was exactly that you did last time? And you attempt to reproduce that exact same adjustment. You eagerly await their next visit only to find that it just was not quite as dramatic, or worse they actually took two steps back after the last visit. What happened? You forgot Rule Number 3 – You adjusted them based on your analysis from days before, and not on the day that they presented: You didn’t “Do Something Different”!

Or you may have observed in the past that when a practice member saw your locum or perhaps visited another practitioner, all of a sudden they got a positive shift in their healing progress that had seemingly halted under your regular care. Was it that the other practitioner was better or more gifted, or smarter than you? No, they just did “Something Different”. Now I know you are thinking that you have seen the opposite scenario whereby a locum or alternative practitioner has done more damage than good – if you are thinking this then make sure you read the postscript below…

So how does Life Rule Number 3 change practice? If you want to maximize the physiological response to each and every adjustment follow these simple steps:

1) Find a technique that gives you certainty that you can discern exactly where and how to adjust on any given visit: If you don’t possess this certainty then please join us at a Torque Release Technique program to share what is perhaps the most consistent educational outcome – confidence in your competence. An adjusting technique that progresses in pace with the person’s response is pivotal to successfully implementing Life Rule Number 3 as a principled Chiropractor.

2) Build into each practice member’s care plan variety, change and progression – make every visit a new experience – not random unpredictable and hence stressful – but evolutionary and intelligent (like their nervous system).

3) Never stop learning new tricks: If you left college and have avoided attending any PD unless coerced to find the cheapest and quickest shortcut program to maintain your registration then shame on you. Commit your time, energy and money to developing yourself – for your patients’ sake if not for your own longevity in practice.

4) Incorporate objective functional assessments into your progress examinations – if you rely on how your practice members are feeling to determine their progress in care then you are at the mercy of anything from the weather, to the economy, even perhaps to astrology. People are going to feel good sometimes and be sick, and feel crook at times but be healthy. But the only thing that improves function is a management plan that works.

5) Cooperatively develop a micro plan and macro plan for your practice members: What do you both want to achieve from the next 6-12 adjustments. What will be the benefits to them if they follow your plan for the next 6-12 years? Conduct regular progress exams and celebrate the small and big steps.

6) If you are feeling somewhat fatigued or jaded in practice then remember Rule Number 3 one more time: “Do Something Different”!

P.S. If you are now pondering how this can really play out in your consulting rooms then there are some tips I have learned from elite athletics training that I find apply to “Doing Something Different” in practice:

A)Don’t try to do everything in one visit: You can’t get fit in one training session, and as much as you may want to be a miracle healer, you won’t fix most people in one visit. So keep some tricks in your bag for subsequent sessions so that variety is easy to achieve – whoever made the rule that every chiropractic consultation should consist of the same experience – but in general it does? Dr Jay Holder teaches a key TRT principle of “Less Is More” – and this can be a hard but life changing principle to implement in the real world, especially when that 50 year old male walks in the room with extreme antalgia and demands for you to crack his back into alignment.

B) Have a plan for a series of sessions versus a plan for each single session. When I start coaching a new athlete, I have a fairly standard progression of drills and activities over a series of sessions that then has to fit and adapt with the athlete’s level of response and completion. Think through a progression of care that you would like to be given yourself if you were just starting out under your own program. I remember hearing of some old-timer therapists in Perth who had a three visit progression: On the first visit you had a hot-pack placed along your spine for a few minutes. On the second visit you had the hot pack, plus a tennis ball was then rolled up and down your paraspinal muscles. On the third visit you received the hot pack and the tennis ball care, and then had your spine manipulated so severely that the noises could be heard in the next suburb. And that was it – you were done! Hopefully you can come up with a more contemporary version of a more ongoing wellness based program?

C) Make each change a gradual progression from the last: In training my rule is only change one variable at a time – up the intensity or up the quantity or up the complexity, but don’t vary any combination of the above. This is a little hard to apply directly to chiropractic care but with some thought you should get what I mean? Let’s go back to the example I mentioned before of the practice member that sees your locum or another practitioner and suffers a significant setback – I guarantee that the other practitioner has either erred on point A (they did too much and tried to fix the person in one go in an attempt to prove how inferior you are and how superior they are) or this point C (the care they provided was too large a jump from what you were doing and the person’s body suffered a shock response).

I have a simplistic point of view to practice design and management: I try my very hardest to design a practice environment, policies and procedures that I would be highly impressed and compliant to pay good money for myself… Would you be happy to visit your own practice on a regular basis, and wait for however long you make people wait, and receive the care that you supply, and pay whatever fee you expect your own customers to pay? If not then it is definitely time to apply Life Rule Number 3 and “Do Something Different”…

The researchers sought to demonstrate that upper cervical specific adjustments would have a positive effect on the physiology, serology and immunology of HIV positive individuals.

Tests were performed on the patients by an independent medical center. The CD4 counts in the regular group were dramatically increased over the counts of the control group. A 48% increase in CD4 cells was demonstrated over the six month duration of the study for the adjusted group.

A small randomised, controlled clinical trial was carried out on two patient groups, each with 5 patients. The regular adjusted group was given upper cervical adjustments to the atlas using the Laney instrument, and for the control group a placebo adjustment was carried out by placing the stylus on the patients’ mastoid process with the instrument emitting no force.

The results are quite remarkable. In summary, the control group experienced a 7.96% decrease in CD4 cell levels and the adjusted group experienced a 48% increase in CD4 cell levels. It would be desirable to carry out follow up studies with far larger groups in an attempt to establish both a link between the nervous system, immune system and upper cervical region.

Super Healthy Tip…

I have seen a diverse number of research papers and case studies over the years which consistently illustrate improvements in immune function when chiropractic adjustments are received. My fairly black and white brain looks at it this way – chiropractic adjustments kick start the immune system. In my own practice if someone rings to cancel their appointment because they’ve “got the flu” – we try to insist that they keep their appointment – and repeatedly we have seen much quicker recoveries in the people who keep their appointments, than the ones who we are still ringing two weeks later to see if they are up to an appointment yet.

But how can this be – someone adjusting your spinal column – improving your immunity?

Consider the following:

Your spinal column houses your central nervous system

Direct nerve connections to immune system tissues have now been isolated

Many of the chemicals of communication found in rich deposits in the spinal cord, have receptor sites on many of the types of white blood cells – so even without direct nerve connections there must be a chemical communication process between the two systems

The key to a healthy immune response is dependent on the recognition and reaction to invading microbes – not only do the white blood cells that encounter a microbe need to know about it – they need to tell all the other white blood cells too – this needs a fully functional communication network – we know this as the nervous system

Malfunction in the spinal column could interfere with this communication network, and correction of this malfunction would therefore restore the network

Health – A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Coaching – A method of directing, instructing and training a person or group of people, with the aim to achieve some goal or develop specific skills.

Health care or healthcare – The prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions.

You pick the sport

Unless you were born behind the iron curtain – you probably picked the sport that you most like to play, and that you have spent most of your spare time participating in. There could have been a number of reasons why you chose to start playing a sport, but guaranteed you would only continue to play the sport if you fell in love with it. Similarly, health coaching allows you to pick the game you want to play – weight loss, increased fitness, less allergies, digestive system that works better, greater flexibility, improved concentration, control over a habit or compulsion…

If you did live behind the iron curtain then they would have put you through a bunch of physiology tests and told you what sport you were going to play – based on their expert opinion. This is a bit like modern health care – if you have a health issue that you want help with you will consult an expert who will run a bunch of tests, tell you what they will do to fix it, and you will do as you are told. And it might not be the game you expected to play: You want to run up a flight of stairs, your doctor wants to reduce your blood cholesterol…

You have the aspirations

What is the highest high you want to attain in your sporting life? Under-16 grand final, or the Olympics; Getting to the shops without becoming breathless, or climbing to the peak of Mount Everest; To make daily living more comfortable, or to discover the limits of your human potential?

With health coaching you get the privilege of setting the height of the bar. With health care you will be given the goal – it is called a normal value – Blood pressure, heart rate, breathing capacity, blood cell count, liver function, cholesterol reading, aerobic capacity, sitting reach, Xray reading…

You turn up to training

Training was banned from the original Olympics – it was supposed to be a test of natural ability. Somewhere between then and now, we worked out that you could develop and maximise your innate potential by training and practising. And if you do the right quantity and quality of training – you can transform from a loser to a winner.

Health coaching says “now is the time to start training for a healthy future – to prevent injuries and to enhance your performance in the heat of the big game”. Health care says “get in there, just play, we’ll patch you up if you tear or break something, and then we’ll rehabilitate you back into the shape you were in immediately before the game”.

You do the work

The coach can’t do your training for you, your team mates can’t compensate for your lack of fitness. In health coaching, the coach designs and schedules your program, but at some point you have to follow the program to get the benefits and the rewards. In health care we hope that there is someone out there who can make us feel the way we would like to feel, “is there a pill that can make this go away?” “Can you put my back in for me?” “The doctor said that they will find the cure for this in a few years.” “I’m on the waiting list for some surgery to fix this problem once and for all!”

It’s all fun

Even the most professional athletes need to have fun to keep them in the game. When the joy has gone, the heart has left, and the motivation will quickly wane. With health coaching you get to participate, and you get to express your personality and you can factor in serious amounts of silliness. Health care is a serious business – you should be impressed by the years of training, the amount of technology, and the visible signs of wealth and authority. And please don’t laugh too loud – you might disturb the other patients!

Playing the game is as important as the results

When I was an athlete, I used to enjoy training as much as I did competing. And the moments of sheer joy and reward weren’t standing on some medal dais; they were the actual microseconds of absolute focus, coordination and motion that constituted each component of the performance itself.

Health coaching offers the opportunity to be in the now – and to discover the healing that comes from becoming more conscious and reconnected with your inner self. Health care will be satisfied when you achieve that negative test result, a normal reading, or the ablation of that pain or discomfort without the need for any form of awareness or awakening.

It’s up to you on game day

You’ve done the training, followed the advice, mastered the rules of the game and now you are faced with the ultimate challenge – will you respond or choke? Health coaching prepares you for the challenges of the real world, and assists you to develop the coping mechanisms, visualisations and affirmations that will equip you for the battles of life. Health care sits on the sidelines and waits for you to fail – it will be there to help you pick up the pieces and maybe come back to fight again another day.

You get the credit

What is the name of Tiger Woods’ coach? How about the guy who taught Michael Jordan how to dribble a basketball? Who gets paid more – the best player in the best team – or the fitness coach? In health coaching you are at the centre of attention – when you achieve your goals you will be the one that everyone notices – how good you look, how much stamina you have, how much energy you exude. In health care the good doctor gets the credit – he’s the one who cured your cancer, removed your pain, knew what to do to save your life, told you which pill would do the job.

You get the blame

Coaches might get sacked, but the players are the ones that bear the brunt of the blame. With health coaching you might dismiss the coach if you aren’t happy with the results, but at some point you have to take responsibility for the fact that it is your body, and you are in control – or should be. In health care you are absolved from your personal responsibility – “that doctor didn’t know what he was doing”, “that chiropractor couldn’t get my neck back in”, “the cure was worse than the disease”. This might sound attractive but it excludes you from the benefits of growth and true healing.

You get the medals

The coach doesn’t get to keep your medals, certificates, endorsements, awards – he just gets a photo of him standing next to you holding your rewards. In health coaching we love to stand alongside you and bathe in your glory. In health care there are no awards for the contestants – the practitioner gets the awards and certificates and the guest spot on Oprah Winfrey…

Who won?

Using a sporting metaphor might lead the reader to take on a competitive mindset: “So is health coaching better than health care?” “Should I choose which team I am going to follow and swear to never cross camps?” “If I see a health coach and still get sick does that mean if I’d been smarter and chosen health care – I wouldn’t have got sick – did I pick the wrong team?”

Now let’s take our competitive hats off – A coach who doesn’t want to work with a team of trainers and therapists in a cooperative effort, will have a short resume’. And health care that only responds to illness crises and lacks a bigger picture of prevention and wellbeing is a sick model.

The name “coach” allegedly originates from the multitasking skills associated with controlling the team of a horse-drawn stage-coach. The ability to get two, four or six horses all going in the same direction at the same time and at the same speed is one to be admired. Make sure that your health care relationships integrate a balanced and symbiotic mix of COACHING and CARE…

Gill and I have just gone through a major change in our practice and personal lives. After 18 years of owning and practising in the one location, we have handed over ownership to another chiropractor. So it feels like an appropriate time to reflect and to share some experiences, and some insight into the challenges and potential of our great profession.

It was an emotionally charged time as we started to tell our patients and practice members that we were going to be moving on and that we were going to be handing over their care to a new chiropractor. And there were three groups whose reactions really impacted me: The first group was those old faithful regular clients who had been seeing me for 15 to 18 years. Some reminded me that they had seen me in my first weeks of practice. A couple of people even reminded me that they’d seen me in the first days of my practice. And they reminded me how young and “green” I was; and many thanked me for how much I had grown up and evolved in that time.

Now, this raises an interesting question: why would someone see a chiropractor consistently, and regularly over a period of 18 years? I can guarantee you that it wasn’t because I signed them up with an 18 year prepayment plan. But instead, they must have some conscious value for the benefits that they receive from their adjustments. And they have enormous experience in terms of how chiropractic has helped them – beyond the relief of an acute low back episode

The second group that probably affected me the most was a group of 18 to 22-year-old’s, who when I told them that I was going to be moving on, and that they were about to be under the care of another chiropractor; they looked at me with sorrow and surprise and even disappointment. And most of them said to me, “what am I supposed to do, you have been my only chiropractor for my entire life. You have kept me healthy for all these years?” - Many of them since birth. And it reminded me of how much children intuitively love chiropractic care when they have a good experience. You don’t need to educate or intellectually explain the benefits of chiropractic to a child who experiences them. It’s like a seven-year-old boy said to me once, “I love getting adjusted, you recharge my batteries”.

The third group that probably surprised me a little was a significant group of people who’d only been seeing me for weeks, perhaps months, maybe a year or two: In the bigger scheme of an eighteen year old practice, not a long time. But they too were shocked and disappointed that I was going to be moving on. I guess every chiropractor has patients like this: People who’d been to every other doctor and had all sorts of medical tests and been to other alternative practitioners. And then they stumbled upon you and the healing magic started to occur. And I realised that this group associated their healing with ME and perhaps not so much CHIROPRACTIC. They also place an enormous amount of value on our adjustments. The next part of their journey, being under a new chiropractor, will be to discover that their healing comes from chiropractic, not from Nick Hodgson.

So here is the big question: Do you underestimate the value of the benefits from YOUR chiropractic to the health and wellbeing of your patients and your community? Are you aware of the changes that are happening in the lives of your practice members?

I know there was a time in my practice life where I underestimated the value of what I did. And I remember sitting in a packed theatre at a Dynamic Growth Congress on the Gold Coast, on a Friday night. And one particular speaker was sharing a case story of someone that he cared for over a long period of time. This patient was in a wheelchair as a result of previous injuries, and as the story unfolded, we saw photos of this guy, looking sickly and drawn, in his wheelchair; through to a time when he was no longer in his chair; and then he was holding a newborn baby; his own son in his arms: Both events that should not have happened – but for a chiropractic miracle. And I can remember sitting in my chair, feeling really tense, and then I broke into a cold sweat, and then tears started to well up in my eyes. And later that night, I was tossing and turning in bed, trying to get sleep, and I realised that there was a deep burning question building up inside of me; and it sounded something like this: “Nick, where are your miracles, where are the miracles in your practice?”

Now you might be thinking that when I got back to practice on Monday morning, that there was a guy in a wheelchair, or a deaf or a blind person, waiting to see me, who had a miraculous healing after I adjusted them, and that from that day on I produced miracles of my own. No, my outcomes didn’t change: But instead what happened was my awareness changed. And over the next few weeks and months I started to notice changes and miracles that had already been occurring in my own patients – I just had never taken the time to notice. And as a result I developed a deeper appreciation for the changes that occur as a result of my adjustments. So, let me ask you again: Do you underestimate the value of YOUR chiropractic care?

How do you start to identify and become more aware of the changes that are happening in your practice? In the past, the main way we used to help ourselves to become aware of our miracles was through the patient testimonial. When we had a patient who had a dramatic response to our treatment, we would get them to write a short story about their experiences. And after a while we would have a collection of a range of these testimonials. But what about all the other patients in your practice? How do you know what changes they are experiencing under your healing hands?

Now is one of the best times to be a chiropractor, because we have so many fantastic tools and technologies to measure and demonstrate what happens as a result of an adjustment: We can use health questionnaires to record someone’s state, at any given time. Anything from a neck disability, or low back pain questionnaire; through to specific health problem questionnaires, like asthma or ADHD or any named illness for which I guarantee you can find the questionnaire that matches the ailment; through to health and wellness, and quality of life questionnaires.

And there are also numerous functional assessment technologies, which can measure almost any aspect of your patient’s physiology. From taking digital photographs, and then using software to analyse their postural alignment; Or digital radiographs, where we can store the images on our computer and draw angles and measurements and calculations to be compared later; Through to surface EMG, paraspinal thermography, and pain algometry, and flexibility inclinometry; and now even heart rate variability, brain EEG, skin conductivity, and bio feedback assessments: You name the thing you want to measure, and the technology probably exists to demonstrate the changes.

So what are the benefits to the average chiropractor of utilising these technologies? The first and most obvious reason is that it helps to identify the miracles that you might otherwise miss. Often people don’t tell you about some of the less predictable changes that have happened in their lives until you see the changes in their physiology, and then they’ll say, “oh so that’s why I’m sleeping better, or playing better golf, or feeling happier?” And like me you’ve probably noticed that sometimes people have short memories. Those people who, when you first met them were in a terrible state, and were struggling to do even daily activities. And after a period of being under your care life is now going pretty well. But then, they say to you, “why do I need to keep coming? I’m not sure whether I’m getting any value out of my adjustments?” And you think “what are you talking about, don’t you remember how bad you were? Can’t you see how much you have improved?” So the benefits of using outcome tools is that you have a “snapshot” in time of what they were like back then, and you can show them and remind them as to how far they have come, and how much value they do receive from chiropractic.

So which tools should you be using in your practice? Here’s a really big question that you need to be asking yourself: What do you claim to change? What changes do you expect to see in your patients when you adjust them? A useful bit of homework to do is to take a blank sheet of paper and down one side list what are the major changes that you focus on that indicate that your chiropractic is working? And come up with a short-list of what are the most important functional improvements that you expect. Is it an improvement in posture, a change in a cervical curve angle, a reduction of muscle tension, improved flexibility, less pain and daily dysfunction, or an increased state of well-being and quality of life? Then, next to each of those listed changes, you need to identify the tool that you can use to prove that you change what you claim to change.

I’ve noticed that this can be really, really challenging for many chiropractors. And there seems to be only two possible reasons why a chiropractor would resist utilising these tools: The first is that they perceive these technologies as being expensive or time-consuming: In fact most technologies are now more than affordable and cost effective than ever before, and can usually more than pay for themselves via the extra revenue they generate: Some can be delegated to staff members who are usually more than enthusiastic to get more involved in the clinical and healing process.

And the second “excuse” appears to be a degree of fear of exposure. “What if I don’t change what I claim to change?” And I guess that are only two possibilities to this scenario: either chiropractic doesn’t work or YOUR chiropractic doesn’t work! But this perception is best resolved by putting the outcome tools to work – You either discover that your chiropractic is working; it’s not working as well as you would like (in which case you can modify your management plans and procedures); or it isn’t working (in which case you will need to discover a way that does work): Any of these three possibilities leads to improved quality in your products and service to your community – a win-win situation for everyone.

It is now the 21st century, and if you are practising in the same manner as you were in the 1990s, then you are not a 21st century chiropractor. Assessment and treatment technologies have evolved greatly in the last decade, including the chiropractic adjustment – there are new ways of adjusting which are gentler and faster, which work as well as, and perhaps even better than the “old” stuff. And there is no doubt that the chiropractic profession needs to redesign its packaging IF it wants to be seen as the leaders of the wellness revolution, as opposed to just another provider of drug-free back treatment.

What will happen if our profession doesn’t embrace the technologies and opportunities of the 21st century? There’s a saying, “put up or shut up”: Show your evidence and be listened to and respected, or stay silent and have your ways of life dictated to by others. I know there was a period in my practice life when I was waiting for the definitive study that proved that chiropractic did what I thought it did – improved state of wellbeing, maximized health and optimised human performance. And that once this paper was published in a legitimate scientific journal, the rest of the world would sit up and listen to us. It’s been eighteen years, and I am still waiting! And the profession is 112 years old, and we are all still waiting. That’s not to say that
there haven’t been some good papers – but the “breakthrough” has not occurred.

Here’s what I have discovered to be a fact: The evidence that chiropractic works exists inside the four walls of each and every chiropractor’s office – they are just not using the tools to prove it – they are waiting silently for someone else to present the evidence – maybe someone really famous and trendy who will receive a chiropractic miracle and do a testimonial on national TV, and then everyone will want to get adjusted??

Imagine if every DC used outcome tools in their practice, and that as a result they had enough evidence in their practice to publish just one case study in their career: That would mean that the Australian chiropractic profession would contribute 2,500 case studies to the evidence base. And the US contingent could produce tens of thousands of case studies. Case studies are a legitimate means of scientific endeavour, and the registration boards can’t silence you from sharing this information with the world.

But here’s what happens if you stay silent, and have no evidence to “put up” – third parties start to dictate to you the terms and conditions of your practice life… When the chiropractic profession shuts up, we wake up one morning and discover that our patients cannot share their success stories with the outside world; we wake up and discover we can no longer use the title Dr. What wake-up call will it take to make you put up your proof? Waking up to discover that it is now illegal for you to care for children; waking up to discover that you can no longer adjust necks because some other profession thinks it’s not safe; that you must discharge your practice members once their symptoms subside; or that if their symptoms haven’t subsided after four weeks that you must refer them to another profession anyway?

Maybe we shut up because we lack certainty? THE BEST solution to a lack of certainty is EVIDENCE: Evidence that what you do makes a difference in the world – and the most convincing way to collect the evidence is through the use of relevant outcome tools to measure what it is that you claim to change. You see, nowadays I have complete certainty that MY chiropractic works exactly as I thought it did; it improves state of wellbeing, maximizes health and optimises human performance – I know this because I have used the tools to measure what I claim to change, and they change!

What are the secret ingredients which define a chiropractic adjustment? What are the features that separate an adjustment from other therapeutic modalities? What are the factors that differentiate a good adjustment from a bad adjustment?

Most definitions of “Adjustment” are very mechanistic in nature: “Moving the joints of the spine beyond a person’s usual physiological range of motion using a fast low-amplitude thrust”; “low-amplitude, high-velocity thrusts in which vertebrae are carried beyond the normal physiological range of movement without exceeding the boundaries of anatomic integrity”. The glaring pitfalls of such predominant definitions are that not all chiropractic adjustments carry the joints into their para-physiological range: Does this mean that SOT Blocks are not an adjustment, and that all instrument-based adjusting protocols are not chiropractic?

Perhaps it is time that we re-define the core components that describe a chiropractic adjustment?

Early chiropractic concepts spoke of universal and innate intelligence, the mental impulse, and proposed that a chiropractic adjustment doesn’t correct anything, but innate utilises the forces transmitted to the body following an adjustment to correct itself: In other words, the body is intelligent, but sometimes needs information from an external source to be able to make better perceptions, decisions and choices.

So, an adjustment is not so much an imposition of our will upon another person’s physiology; as it is the delivery of a new and enlightening piece of information which attempts to facilitate neurological change.

Torque Release Technique defines an Adjustment as “communication through touch”. What are the fundamental factors of this healing touch?

The times signs indicate that each factor has a more significant impact on the other and on the total result than if instead the addition symbol was present; and that if all factors are present the resulting answer will be huge:

For example, in mathematical terms if each factor = 10, then A = 10 × 10 × 100 = 10,000

If the symbols had been additive the answer would be A = 10 + 10 + 100 = 120

The square symbol shows the “I” factor has the potential for greater impact: If this factor is small then the formula will not change much. Increase this factor and its impact becomes greater and greater at an exponential rate:

For example if we alter our original formula so that I = 1, then A = 10 × 10 × 1 = 100

Whereas if I = 100, then A = 10 × 10 × 10,000 = 1,000,000!!

Now let’s define the factors in more detail:

Force = Mass × Acceleration:

This is an old Newtonian formula. Every adjustment has force – an adjustment with no force at all is just a good intention. To increase force we either increase the mass or the acceleration, and if you increase both then the force greatly increases. In terms of a chiropractic adjustment, any experienced chiropractor knows the importance of speed over mass: The quicker you are the less the mass you have to use, and the more easily an adjustment is accepted. I guarantee that an adjustment will appear “heavy-handed” to a client due to excessive mass, and not due to excessive speed

Correctional Vector = Contact Point + Three-Dimensional Vector:

The force of an adjustment must have a point of contact and a direction: Specificity is what separates chiropractic adjustment from so many other therapeutic modalities, and without correctional vector I doubt that chiropractic would have attained separate and distinct status. Firstly we are more discerning in where we place our hands; for example, we don’t just stretch the lumbar spine, we adjust an L5.

Also integral in most chiropractic adjustment protocols is the direction in which we apply our force: Our predominant “listing” systems incorporate three letters to define the direction and combination of vectors in three dimensions, which we utilised in our adjustment. And we may even add a fourth letter to further define our contact point… For example: C2 PLI-S – we contacted C2 and our vector was in a direction to reduce the left and inferior vectors of the subluxation, and we used the spinous process as the contact point.

Intent = Become One + Visualisation + See Whole

R.W. Stephenson described the essential components of intent. Intent could be simply explained as what we are thinking about as we deliver an adjustment. But it can also mean much more than this as it may include our own emotional, physiological and even spiritual states.

“Become One” encompasses an almost spiritual connection that occurs when we as a practitioner enter into another’s “energy” or “intelligence” field. The insinuation is that when we come so close there is an influence between the two fields of intelligence. This has ramifications at a diagnostic level in the sense that we can potentially gather much deeper levels of information if we are perceptive to the other person’s “field”; and at a therapeutic level we potentially enter into a deep level for the transaction of information taking place.

“Visualisation” defines the need to see what we are doing: Can we imagine the structures and tissues that we are examining; can we envisage the impact that our testing and corrective vectors are having on the person’s physiology; can we see the effects of our adjustment before they actually occur?

“See whole” describes our intent: Wholeness. After our practice member is adjusted their mind/body is able to better perceive itself, the communications between mind and body are restored, and their physiology becomes more efficient and effective. Do you expect this? Do you actually SEE this occurring in your mind’s eye?

What separates an adjustment from other therapeutic modalities? The size of each factor illustrates its relative importance in the formula:

Massage = f ( m × a ) × CV × I2

Therapeutic massage is separated from relaxation massage by how deep the practitioner penetrates; that is by how much mass they use: Mass is probably the most dominant vector in the therapeutic formula. Acceleration is extremely small as most massage involves slow strokes. The vectors are usually unfocussed and very mixed, sometimes the more directions you sweep across a muscle the better. Intent is somewhat diminished due to poor visualization (most masseurs have inferior anatomical and physiological knowledge) but will have a high degree of connection and a desire to see whole.

Manipulation = f ( m × a ) × CV × I2

Manipulation is usually a mechanistic attempt to produce separation and preferably cavitation of joint surfaces: The Mass is increased and Acceleration is relatively high to achieve this end. Correctional vectors are minimised usually only involving two dimensions and are not seen as so important many times both directions/sides being manipulated to maximise the stretch effect. The intent is small, the need to become one being irrelevant, visualization being for the purpose of finding the structure to be manipulated and the outcome seen being no bigger than to cavitate a joint or to increase flexibility.

Acupuncture = f ( m × a ) × CV × I2

An acupuncture needle delivers minimal mass with no acceleration, so force is almost absent. The correctional vectors are so important, much care being taken in the location of the needles and in the precision of their insertion. The contact points are very different to a chiropractic adjustment relying on a totally different bodily system. The vitalistic intent of the acupuncturist must be considered equal to that of the principled chiropractor as they too expect great things from their therapeutic modality and it could even be argued that they are bolder in their therapeutic claims.

What differentiates a great adjustment from a bad adjustment? The adjustment with “that something extra” requires a precise combination of the secret ingredients…

Great Adjustment = f (m × a ) × CV × I2

Bad Adjustment = f ( m × a ) × CV × I2

Keys to the adjustment with “that something extra”…

Maximise acceleration and minimise Mass.

Utilise a precise system to determine the most effective combination of contact point and correctional vectors.

Maximise Intent by respecting and perceiving the connection between you and your practice member, visualizing every aspect of your analysis and correction, and having a clear picture of the intended outcomes.